Provider Demographics
NPI:1821092719
Name:JOHNSON, EULALIA DARLENE (DC)
Entity Type:Individual
Prefix:
First Name:EULALIA
Middle Name:DARLENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2303
Mailing Address - Country:US
Mailing Address - Phone:972-563-1557
Mailing Address - Fax:972-563-1527
Practice Address - Street 1:1409 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2303
Practice Address - Country:US
Practice Address - Phone:972-563-1557
Practice Address - Fax:972-563-1527
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001444101Medicaid
TXT79020Medicare UPIN
TX602039Medicare PIN